Sellar Defect Reconstruction with Vascularized Superior Turbinate Mucosal Flaps in Endonasal Endoscopic Transsellar Approach
| Autor: | Ozan Durmaz, Soner Yaşar, Çağlar Temiz, Mehmet Can Ezgu, Abdullah Durmaz, Yusuf Izci, Alparslan Kırık, Cahit Kural, Murat Kutlay, İlker Özer, Mehmet Daneyemez |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
Male Natural Orifice Endoscopic Surgery medicine.medical_specialty Leak Superior turbinate Cerebrospinal Fluid Rhinorrhea Nose Autologous tissue Surgical Flaps 03 medical and health sciences Postoperative Complications 0302 clinical medicine Cerebrospinal fluid medicine Humans Mucocele Aged Retrospective Studies Skull Base business.industry Defect reconstruction Middle Aged Plastic Surgery Procedures medicine.disease Surgery Nasal Mucosa Skull medicine.anatomical_structure 030220 oncology & carcinogenesis Neuroendoscopy Female Neurology (clinical) business Complication 030217 neurology & neurosurgery |
| Zdroj: | World Neurosurgery. 133:e503-e512 |
| ISSN: | 1878-8750 |
| DOI: | 10.1016/j.wneu.2019.09.082 |
| Popis: | Background The pedicled nasoseptal flap (NSF) constitutes the primary reconstructive option for most skull base defects in endonasal endoscopic approaches. The superior nasal turbinate (ST) has received little attention. We report our preliminary experience with the use of the ST mucosal flap in selected cases. Methods We performed a retrospective review of patients who underwent endonasal endoscopic approaches and identified 9 patients who were reconstructed with vascularized ST mucosal flaps as part of a double-layer or triple-layer reconstruction. When there was no intraoperative cerebrospinal fluid (CSF) leak, we used a double-layer technique. If there was an intraoperative CSF leak, regardless of the quality of leakage, we preferred a triple-layer repair technique. In patients with high-flow leaks, triple-layer repair was performed using only autologous tissue grafts and flaps. Results Intraoperative CSF leaks were noted in 7 of 9 patients. Among them, 4 patients had low-flow CSF leaks (grade 1 and 2) and 3 patients had high-flow CSF leaks (grade 3). All reconstructions had complete defect coverage with the ST flaps and NSFs were preserved. All the flaps were viable at 4 weeks without a CSF leak or complication at the reconstruction site. There was no contraction or partial loss of the flap. After a mean follow-up period of 9 months, none of the patients required a flap revision, developed a mucocele, infection, or other complication. Conclusions An ST flap can be used for the vascularized reconstruction of sellar defects if it is bilaterally available. This option should not be overlooked and wasted. |
| Databáze: | OpenAIRE |
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